It’s been a record-breaking open enrollment period for states across the country, with more than 24 million people enrolling in coverage under the Affordable Care Act. If you missed signing up, you don’t necessarily have to wait until the fall to enroll in a plan. If you experience a life-changing event or a shift in your circumstances, a Special Enrollment Period (SEP) may open. This unique opportunity allows you to sign up for health insurance outside the regular enrollment window if you meet certain qualifications. Knowing when and how you can update your health coverage is critical. Let’s explore what qualifies and how you can make the most of an SEP. 

Loss of Health Coverage 

  • Job Loss: Losing health insurance coverage due to job loss, including voluntary or involuntary termination, qualifies you for an SEP. 
  • Aging Out: Turning 26 and aging out of a parent’s plan is a common qualifying event. 
  • Expiration of COBRA: The end of COBRA coverage also opens an SEP on the exchanges for individuals. 
  • Loss of Medicaid or CHIP: Losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP) allows you to apply for new coverage. This is critical as Medicaid redeterminations continue across the country. 

Household Changes 

  • Marriage or Divorce: Getting married or divorced can affect your health insurance needs and may qualify you for an SEP. 
  • Birth or Adoption: The addition of a new family member, whether through birth, adoption, or foster care placement, triggers an SEP. 
  • Death: Losing a family member who was a part of your health insurance plan may qualify you for an SEP to make necessary changes to your coverage. 

Relocation 

  • Moving to a New Area: Moving to a new ZIP code or county, moving to the U.S. from a foreign country or United States territory, if you’re a student moving to or from the place you attend school, or a seasonal worker moving to or from the place you both live and work, qualifies you for an SEP. 
  • Change in Residence for Other Reasons: Other changes in residence, such as moving to or from a shelter or other transitional housing, also qualify. 

Other Qualifying Events 

  • Changes in Income: Significant changes in household income that affect the coverage you qualify for can trigger an SEP. 
  • Gaining Membership in a Federally Recognized Tribe or Status as an Alaska Native Claims Settlement Act (ANCSA) Corporation Shareholder: Members of federally recognized tribes and ANCSA shareholders can sign up or change plans once a month. 
  • Error, Misrepresentation, or Inaction by an Insurance Company or Advisor: Errors or issues in the enrollment or disenrollment process can also qualify you for an SEP. 
  • Gaining or Losing Eligibility for Premium Tax Credits or Cost-Sharing Reductions: Changes that affect your eligibility for financial assistance may open up an SEP. 
  • Becoming a U.S. Citizen: Gaining citizenship or lawful presence in the U.S. qualifies you for an SEP. 
  • Release from Incarceration: Being released from jail or prison is a qualifying life event. 

Special Enrollment Period for Low-Income Individuals 

In addition to the qualifying life events mentioned above, there’s a permanent SEP for individuals whose household income does not exceed 150% of the federal poverty level (FPL). This SEP allows eligible applicants to enroll in an ACA-compliant health plan through the Marketplace year-round. To qualify: 

  • Your household income must be at or below 150% of the FPL. 
  • You must be eligible for a premium tax credit. 

This SEP is available in states that use HealthCare.gov and in states that operate their own exchanges. Coverage will take effect on the first of the month following plan selection.  

How to Apply for an SEP 

If you experience a qualifying life event, you generally have 60 days from the date of the event to enroll in a new health plan or change your existing plan through the Health Insurance Marketplace. That timeline can vary, depending on the QLE. To apply, you’ll need to provide documentation of the qualifying event and complete the application process on your state’s health insurance exchange website. 

Life can be unpredictable, but your health insurance shouldn’t be. By understanding the Special Enrollment Period and the events that trigger it, you can stay prepared to secure the coverage you need. Whether it’s a major life event or a change in income, acting quickly and staying informed can make all the difference. Be proactive, explore your options, and ensure you and your loved ones have the protection you deserve when it matters most. If you’re unclear where to go to purchase a plan during the SEP, click here for more information.